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Full text of "Statement of the grievances of the poor law medical officers, with remarks on sanitary measures and vaccination, addressed to the Right-Hon. Viscount Palmerston ..."

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STATEMENT 



OF THE 



GRIEVANCES 



OF THE 



POOR LAW MEDICAL OFFICERS, 



WITH REMARKS ON- 



SANITARY MEASURES AND VACCINATION, 



ADDRESSED TO 



4tyt Eigjrt-imt. ffamA f nltrata, ».#., &.€.%. 

by <ryf3./6 

RICHARD GRIFFIN, 

CHAIRMAN OF THE 
POOR LAW MEDICAL REFORM ASSOCIATION. 



WEYMOUTH: 
D. ARCHER, ROYAL LIBRARY, ESPLANADE. 

1857. 



12, Royal Terrace, Weymouth, 
December 22nd, 1856. 



My Lord, 



To you, as the Premier of this kingdom, I most 
respectfully address the accompanying statement. There is at this 
moment a general feeling throughout the country, that measures of 
vast importance will be brought forward by Her Majesty's Ministers 
during the next Session of Parliament, — amongst these, the Sanitary 
state of the people, Vaccination, and the more adequate remuneration 
of the Poor Law Medical Officers, it is hoped, will hold a prominent 
position ; I therefore venture to lay before your Lordship the sub- 
joined remarks, which I feel sure will meet with your serious and 
patient consideration. 

The claims of the Poor Law Medical Officers, upwards of 3,000 
in number, for an equitable adjustment of their salaries are of far 
greater importance than they may superficially appear, and ought not 
to be lightly treated, as they, in reality, involve the well-being of at 
least 4,000,000 of Her Majesty's subjects, who compose the labour- 
ing classes. Innumerable appeals have been made to the Boards of 
Guardians and Poor Law Board to redress the grievances of their 
Medical Officers, but without avail ; it is therefore to the Legislature 
only they can now look for justice, which they trust will not be 
denied them. 

To prevent the necessity of quoting repeatedly the source of the 
information which I deem requisite to lay before your Lordship in 
support of my statement, I will here mention, that whenever 
numbers are prefixed to the head of a paragraph, they denote evi- 
dence laid before the Select Committee of the House of Commons on 
Medical Relief, in May, 1854. 

Believing the accompanying remarks, if made public, may in some 
degree assist Her Majesty's Government in carrying out measures 
for the improvement of the Sanitary condition of the people, I intend 
to publish and transmit a copy to each Member of Parliament. 
With many apologies for trespassing so long upon your Lordship's 
valuable time, 

I have the honor to be, 

My Lord, 
Your Lordship's obedient servant, 
RICHARD GRIFFIN, 

Chairman of the Poor Law Medical 
Reform Association. 

The Right Hon. 

Viscount Palmerston, K.G., G.C.B. 



POOR LAW MEDICAL REFORM ASSOCIATION. 



In May, 1856, the Poor Law Medical Officers of England and Wales 
held a Meeting in London, over which the 

Right Hon. the Earl of Shaftesbury presided. 

At this Meeting there were assembled, from all parts of the kingdom, 
upwards of 200 Medical Men, who prepared a Petition to the House of 
Commons, and a Memorial to the Poor Law Board, both of which were 
numerously signed, and presented to their respective destinations; and 
dining the Session, nearly 260 Petitions and Memorials from the Officers 
of as many Unions were likewise presented. These Petitions and Memo- 
rials embodied certain requests, founded upon Resolutions of the Select 
Committee of the House of Commons on Medical Relief, which sat in 1854. 
Of these Resolutions, it will be necessary, in the first instance, to consider 

No. 4. — " They also recommend that the Poor Law Board should direct 
their attention to the Salaries of the Medical Officers, which in some cases 
appear to be inadequate to the duties they are required to perform." 

This Resolution the Medical Officers regret to say has not been com- 
plied with by the Poor Law Board, they therefore pray that the Legis- 
lature will direct it to be carried out, and they respectfully submit that it 
may be done in the following manner. 

First, — "That a uniform scale of 'payment should be adopted throughout 
the entire kingdom. " 

In order to ascertain the exact amount of the pajnnents, Questions were 
issued to the Poor Law Medical Officers, and from 500 answers already 
received, it will be seen that neither the Poor Law Board nor the Boards 
of Guardians have acted on any rule in fixing the salaries, as they vary 
from 3^. to £1. 165. 8d. per case. In the Weymouth Union, where I am a 
Medical Officer, it is from Is. 2ld. to 14s. per case, the Paupers on an 
average being equally distant from the Medical Officer's residence ; in 
many other Unions a similar disparity exists. From the annexed Summary 
will be seen the great variation of the salaries, those under Is. being as low 
as 10^., 9d., 7d., 5d., 4d., and 3d. per case. 

s. d. £ s. d. 

28 Medical Officers receive between ... 3 and 10 

35 1 16 

48 1 6 2 

69 2 2 6 

71 2 6 3 

55 3 3 6 

49 3 6 4 

32 4 4 6 

24 4 6 5 

14 5 5 6 

10 5 6 6 

10 6 6 6 

7 6 6 7 

12 7 8 

10 8 9 

8 9 10 

3 10 11 

2 11 12 

3 12 13 

4 13 14 

2 14 15 

1 ... 15 16 

1 16 17 

1 17 18 

1 1 16 8 

500 



o 

These figures prove incontestibly the absolute necessity of Parliament 
laying down a uniform and equitable scale of payment, and thereby 
removing the responsibility from the Poor Law Board and the Boards of 
Guardians, both of whom have clearly proved their utter incapability of 
dealing rightly in an affair of such importance to the poor, as well as to 
the Medical Officer. 

No. 12. (R. B. Cane, Esq.) — "The Boards of Guardians in the first 
instance, fix that salary, subject to the approbation of the Poor Law Board, 
and when that salary is approved of by the Poor Law Board, is it in the 
power of the Board of Guardians to alter that without leave ? The Law 
has confided in the Poor Law Board the absolute power of fixing the 
amount of salary irrespectively of the Board of Guardians, and if they 
please, they can exercise that authority without reference to the Guardians ; 
but the general mode is to consult the Guardians, to enquire what they 
deem to be a proper salary, and having considered their answer, and 
their views, then to determine what shall be the salary assigned to the 
office." 

No. 2688. (G. Wallis, Esq., M.D.) — " At the present moment there is no 
principle operating upon which they are to calculate the amount of pay- 
ment, it is a mere arbitrary arrangement between the parties." 

The Poor Law Medical Officers in their second request pray — 

" Tliat a fixed salary, founded on the average number of cases attended 
during the last three years be adopted, the sum to be calculated at not less 
than 5s. per case, with at least Is. extra for each mile the patient resides from 
the Medical Officer's house." 

This request must be deemed extremely moderate when it is taken into 
consideration, that from the returns already received, the duration of sick- 
ness averages 28 days and one horn*. 

No. 985. (B. Kettle, Esq.) — " South Staffordshire General Hospital 
average duration of illness, a fraction less than 30 days." 
" Birmingham a fraction less than 28 days." 

Of the 500 returns already calculated, the average by salary is 2s. 3d. 
per case, extras, 6id. or 2s. 9 id. on the whole. 

No. 166. Mr. Cane, of the Poor Law Board, says — "My impression is 
that, taking the whole kingdom together, the payment per case to a 
Medical Officer would not average more than 3s." 

In the 500 returns, those for attendance on the Union Houses are ex- 
cluded, hence the majority are for country districts, which fully prove that 
the payments are totally inadequate to the expenses incurred, omitting 
altogether any remuneration for professional skill, &c. The nature of the 
outlay I will now explain, and commence with the item of drugs, the cost 
of which it is difficult for a Medical Officer to estimate, as they are taken 
from a general stock for Union and private practice, but in public institu- 
tions the information may be easily obtained : — 

s. d. 

In the Leominster Union it is per case 1 01 

Hertford Dispensary 2 7 

Township of Leeds 1 4 

Plymouth Dispensary 1 4 1 

Dispensary at Leeds, supported bv ) -, K x 

Charity / l D? 

Exeter Dispensary ..: 1 11? 

Burton upon Trent 1 10? 

North Staffordshire 1 3 

Atherstone 1 

Cheshire 1 1 1 

Carlisle 1 6 



No. 986. (R. Kettle, Esq.) — " Cost of each out-patient in the South 
Staffordshire General Hospital, 2s. Hid." 

No. 169. (R. B. Cane, Esq,) — " I think there is a statement that the 
average expense of drugs alone in the principal Hospitals in London, 
exceeded 2s. 6d. per case." 

No. 3269. (C J. F. Lord, Esq.) — "Whereas the average cost of drugs 
alone, for a single case, required in the practice of Surgeons at Dispensaries, 
where they relieve the same class of persons as the Medical Officers of 
Unions, amounts to 2s. \\d., and in Hospitals to 4s. 4id." 
" In the Great Yarmouth Hospital it is 3s. 8d." 

The estimate may, therefore, fairly be set at not less than Is. Gd. 
per case for drugs. Though I am aware it is done at a lower rate 
in a few places, but the poor are to be pitied, who are compelled to 
take those cheap and inert materials. Other items, however, are to 
be taken into calculation, as it is unfair to expect that Medical Men 
should find, gratuitously, for the use of the nation, a surgery, dispenser, or 
have the labour of mixing the medicines themselves, fire, candles, or gas, 
general wear and tear, besides the annoyance of a host of paupers sending at 
all times of the day to the house for medicines, (very few come themselves 
for advice, but take good care to compel the Surgeon to visit them.) To 
estimate the value of these items, it is necessary again to look at the cost of 
dispensaries throughout the country, as they are generally managed most 
economically, and approximate more nearly to Union practice than any 
other Institutions. In a report of the medical charities of the metropolis, 
by Dr. Guy, (See Athenceum, December 27th, 1856,) it is stated there are 
sixty Dispensaries in the metropolis, where are relieved 232,878 patients 
annually, at an expense of £29,064, or 2s. 5 Id. each case. We thus arrive 
at the cost of medicines, surgery, dispenser, &c, on an extensive scale ; an 
amount, which is only one farthing less than I propose should be allowed 
the Poor Law Medical Officers. A large proportion of these dispensary 
cases are no doubt trivial, and orders for them would be refused by a 
Relieving Officer ; in addition, few of these patients are visited at|their own 
homes, which is the reverse in Union practice. They therefore do not 
entirely afford a true criterion of the services performed by the Poor Law 
Medical Officer. In country towns, however, the same facilities of admission 
do not exist, and the sick are compelled to obtain tickets, which are princi- 
pally given in severe cases of illness, hence the expenditure in these 
institutions is greater than those in London ; but at the same time they 
approach more closely to Union practice, where orders are also requisite. 

s. d. 

Reading Dispensary 6 5 

Bury 8 4i 

Spalding 7 111 

Leeds 4 5 

Ludlow 7 4* 

No. 2035. (R. W. Rumsey, Esq.) — " The average expense of the 
Gloucester Dispensary for ten years was about 5s. 6d. per case, including 
all expenses." 

As the services of the Prescribing Medical Officers in Dispensaries are 
gratuitous, we get at the lowest cost per case for the use of a Surgery, 
Coals, Candles, Dispensing, &c. 

From the foregoing figures, I propose to take Is. 6d. as the cost of drugs, 
and Is. only for the use of Surgery, compounding, and dispensing the medi- 
cines, &c. &c. for the Union patient, and to charge the other 4s. 6d. to the 
private practice where there is any, and where there is not, to the pocket 
of the wretched individual who has the guardians only to reward him. 
The next items to be taken into consideration are professional skill, (the 



attainment of which has cost on an average little less then £1000,) bodily 
fatigue and mental anxiety. These I presume have hitherto been regarded 
as above price, assuredly no price has been paid for them, but is this just? 
can it be permitted to continue ? I unhesitatingly declare the system of 
payment to the»medical officer is cruel in the extreme; it is a system that is 
based either on the robbery of the Medical Officers or of the poor ; in either 
case it is a stigma on the nation that countenances it now that its abuses 
are clearly pointed out. How has it acted hitherto? the majority of the 
Medical Officers are high-principled men, and have faithfully discharged 
their duties to the poor, giving them Quinine, Cod Liver Oil, Sarsaparilla, 
Leeches, &c, when required, which their niggardly salaries never paid for, 
they have therefore literally relieved them out of their own pockets. 
Others there are, who have not the private means to purchase these 
expensive drugs, the result of which is that Hospitals and Dispensaries 
are crowded with supplicants for relief, and the ratepayers burdened 
with the support of their families, which would not be the case, if 
a fair remuneration were made to the Medical Officer. To obviate 
this discreditable state of matters, I propose that each Medical Officer 
shall receive for professional skill, bodily toil, and mental anxiety, 
2s. 6d. each case, a small sum when it is considered that the duration of 
illness averages upwards of one month, and that in my own case I have paid 
on an average ten visits to each patient, a fair sample of the whole. 

The payments will stand thus : — s. d. 

Drugs per case 1 6 

Use of Surgery, Dispensing Medicine, &c. ... 1 

Professional advice and visits 2 6 

5 

In country districts an additional allowance should be made for the cost 
of a horse, gig, and man servant, which are imperatively necessary — these 

at the lowest computation, one year with the other, amount to £87 6s., as 

the following items shew : — £ s. d. 

Annual deterioration of horse from injuries, \ lft n 

ill health, age, or death j 

Food 30 

Shoeing and Clipping or singeing in winter... 2 10 

Man Servant, wages, food and tax 25 

Gig repairs and replacing 10 

Duty on horse and gig 1 16 

Harness, repairing and replacing 3 

Stable 5 



£87 6 



My own expenses for the above, average about £100 per annum. 
It may be urged that a gig need not be kept, but it is impossible for a 
Medical Man always to ride, the fatigue is too great, and a horse con- 
tinually at work gets weak in the knees, which renders him unsafe, and a 
Union Medical Officer cannot afford to be frequently changing. Some 
may say the same horse, &rc, will do for private as well as Union practice, 
but it must be borne in mind that a young Surgeon taking the appoint- 
ment, will for the first few years have little, if any, private practice, and in 
many instances the Union duty is the entire work of one horse, nay, some- 
times of two ; but even if it be used for the private patients, which are 
few compared with the paupers, it must be recollected the country 
Surgeon has no other compensation beyond that allowed the Medical Man 
resident in a town, though he has to endure great loss of time in travelling 
immense distances, and has to undergo an enormous amount of mental and 
bodily fatigue, out at all hours and in all weather, exposed to the pitiless 
storm, frequently drenched to the skin, and passing the greater part of 



many a night in some wretched hovel. No marvel that his days are 
shortened, and the average duration of his life is less than in any other 
profession ; and that, thus prematurely cut off, he too frequently leaves his 
wife and children penniless, and supplicants for relief from that noble 
institution the Royal Benevolent College. 

" The Surgeon of the Sherborne Union, who has just resigned, (Lancet, 
Dec. 13th, 1856,) had travelled during one year, 3,111 miles, and 
that in nine years two horses were worn out in the work; that for 
this travel and time, to say nothing of drugs, (the consumption of 
which is at times frightful,) the salary is £63 a year besides extras 
— a wonderful matter truly — some £25 or £30 a year, for amputations, 
fractures, labours, swelling up to a total so tempting, that if any ' young 
man,' (to whom one of the Guardians thought it would only prove a little 
pleasant riding) is disposed to try it, he may rest assured a very few years 
of such work will go far towards making an old one of him." 

The foregoing conclusively proves the absolute necessity of an allowance 
being made for ahorse, &c, and I know of no way so fair as that proposed 
in the Petition of the Union Medical Officers, that a mileage be paid of not 
less than one shilling per mile for each case the first four miles, and after 
that two shillings per mile, thus, if a Medical Officer live three miles from 
his patient's residence, he will be paid as follows (the average distance in 
250 returns is 3 miles.) s. d. 

For Drugs per case 1 6 

Use of Surgery, Dispensing, &c 1 

Professional advice and visits 2 6 

Journey to be paid only once during an illness ... 3 

8 

As an example of mileage, awarded by the Legislature to an Officer 
who has neither mental anxiety nor night work to trouble him in its per- 
formance, who is not required to keep a horse, as the summons may be 
served at his leisure by any inferior person employed by him, I will 
quote the schedule for the remuneration of a High Bailiff, by which it will 
be seen, he is paid Is. 3d. for going three miles, whilst the Poor Law 
Medical Officer asks only 3s. for travelling thirty miles, the average distance 
of his patients' residence being three miles, and the number of his visits ten. 

Schedule for the remuneration of High Bailiffs. 

Maximum Salary £600, and in large districts £100 will be 
added in the shape of Responsibility-money. 

An allowance for mileage on the service of Summons. 

S. d. TOTAL FOR MILEAGE. S. d. 

Within 1 mile ... 4 4 

2 miles ... 5 Extra 9 

3 " ... 6 1 3 

4 " ... 7 1 10 

5 " ... 8 2 6 

6 " ... 9 3 3 

7 " ... 10 4 1 

8 " ... 11 5 

9 " ... 1 6 

and 1 per mile for every mile above 
that distance. 



For Executions and Commitments 

Under £5 2 6 

£5 and under £10 5. 

£10 and upwards 10 

and double the above mileage upon all. 



The mode of payment by mileage would contribute materially to the 
benefit of the poor, as Guardians would take care to reduce the districts as 
much as possible in order to save expense, and the poor would not then 
have to travel enormous distances for their medicine ; which many now 
have to do, some of them going so far for that purpose as twenty miles, out 
and home. There need be no difficulty in regard to the calculation of 
the mileage, if a rule be laid down that all cases shall be reckoned from 
a central populous part of each village. If a mileage be not adopted, it 
will be necessary to pay the Medical Officers a fixed allowance for a horse, 
or an increased sum per case, as an equivalent. In order to estimate the 
cost for a horse, &c. at per case, we must ascertain the exact amount of 
salaries paid in any one year, and as 1854 is the last that is publicly 
recorded, I will take that as my guide ; it gives the 3,200 Union Medical 
Officers £230,777 amongst them, or an average of £72 2 41 each, if this 
be divided by 2s. 9f d., the amount now paid per case, according to the 
500 returns calculated, it will give to each Medical Officer an average 
of 512 cases to attend in the year. If the horse expenses £87 6s. 
be divided by these figures, we shall have 3s. 4|rf. as the cost of each case, 
which ought to be added to the drugs, surgery expenses, and professional 
advice, making in the whole 8s. 4:%d. for every case attended by the 
Country Surgeon. It must not however be supposed that a Medical Man 
enjoys the full benefit of the average payment of the £72 2 41., after the 
deductions for drugs, &c, as he has in some instances to pay 2s. weekly for 
the conveyance of the book to the Board, and all have to pay Income Tax, 
Assessed Taxes, and Tolls, which ought to be abrogated in the case of the 
Union Medical Officers ; the last item costing, in some instances, as much 
as £5 annually. The Clergyman goes free of toll to administer to the 
spiritual welfare of the Poor, and why not the Union Surgeon who attends 
to then bodily ailments ? 

In all large towns it is desirable that the Guardians should have the 
option of finding a Dispensary, Dispenser and Medicines for the poor, and 
of employing the Medical Officers purely in the capacity of Physicians and 
Surgeons, in which case the drugs should be found by the Poor Law 
Board for the respective Unions ; if this be not done, the tendency of the 
Guardians will be to procure them by contract of the retail druggists of the 
place, on the principle that as they are rate-payers, they ought to have the 
privilege of supplying them. I need scarcely add, this should not be per- 
mitted, as on the purity of a drug may depend the life of many a poor man. 
An impurity is difficult to detect, hence the necessity of procuring medi- 
cines at first-rate wholesale houses, and not tendering for them at all. In 
country districts and small towns, the present plan of the Medical Officer 
supplying the medicine is the only one practicable ; Leeches and Cod Liver 
Oil ought, however, to be extras, and found by the Guardians, otherwise, 
from their great expense, the poor will never reap any real benefit from 
them. 

No. 140. (R. B. Cane, Esq.) — "I believe it is found advantageous that 
the drugs should be supplied by the Guardians, in certain Unions, where 
they can be readily obtained by the poor. I assume that it is advantageous, 
because where the Guardians have adopted that arrangement they gen- 
erally adhere to it. I do not remember an instance where a Board of 
Guardians, having agreed to provide drugs, have abandoned it after a 
trial." 

No. 142. (R. B. Cane, Esq.) — "In a Union, where the population is 
widely scattered, it w T ould be necessary not only to provide drugs, but a 
house and dispenser, which would occasion considerable expense, and is 
the chief obstacle to its being carried out." 

No. 2051. (H. W. Rumsey, Esq,) — " I think that in towns of a certain 
population, the medicines should not be provided by the Medical Officers, 
but in remote rural districts, the present system, with some modification, 
must be continued." 



10 

No. 471. {R. Weak, Esq.) — "I think, upon the whole, balancing the 
advantages and disadvantages, it is better that the Medical Man should 
find the drugs, than that the Boards of Guardians should do so." 

No. 693. {J. F. Gilbert, Esq.) — " I consider the system of finding drugs, 
and paying the Medical Officer's salary, has many advantages." 

No. 694. (J. F. Gilbert, Esq.) — " Our drugs are better, because as a 
Corporation we are able to deal with some of the first houses in the kingdom, 
and get the best of drugs." 

The system tried in many places, and still carried out in a few, of having 
only one Medical Officer to a Union, is fraught with much mischief to the 
poor, as it is utterly impossible for any one man to do the duty required of 
him. The mass of the evidence laid before the Select Committee of the 
House of Commons, is to the effect that the districts should be lessened 
as much as possible, and the number of the Medical Officers increased. 

No. 1630. {Dr. J. Griffin.) — " I think the poor have a great deal too far 
to send for medical attendance ; very frequently the districts are too large, 
and not sufficiently supplied with Medical Men for the interests of the poor." 

Much surprise has been expressed that Medical Men should retain their 
appointments, if they are really so worthless as represented ; or, that when 
vacancies occur, there is no difficulty in finding candidates for the office 1 
The answer is simple. Resignations are continually taking place ; out of the 
500 returns examined, 209 Medical Officers have held their appointment less 
than 6 years ; 114, less than 4 years ; 68, less than 2 years ; and 32, less than 
1 year. Do not these figures speak volumes? Some there are who retain 
their appointments at a dead loss, for the sole purpose of keeping a rival 
out of the district where their private practice is situated ; but is it to be 
expected, under such circumstances, the duty is performed with that 
alacrity and cheerfulness it would be, were a fair compensation made ? 

No. 1545. {Rev. C. Oxenden.) — " Medical Men must take these offices 
to save their other practice." 

When vacancies occur, I admit there are applicants for the offices, and 
in most cases, they are young men who have just passed their examinations ; 
they try it for two or three years, and finding themselves out of pocket by 
it, resign in disgust ; almost the only instance in which they are retained, 
is when a private practice is purchased by them in the same locality. 
Is it wise for a Government to sanction this constant mutation ? Is it well, 
that as soon as a man has gained experience at the expense of the poor, he 
should be compelled to resign for want of a fair compensation ; and that 
another, it may be of the inexperienced, be encouraged to accept his ap- 
pointment, which, if he does his duty to the poor, must ultimately im- 
poverish him? The Poor Law Commissioners have themselves acknow- 
ledged the injustice of this paltry payment, by their recommendation for 
the relief of permanent poor (Arts. 75 and 76 in the Consolidated Order), 
which states that " the Medical Officer should receive 6s. or 6s. 6d. per 
case in the rural districts, and the remuneration per case for those not on 
the pauper list may reasonably be on a somewhat higher scale ; but the 
Board are inclined to think that it will not be found necessary to exceed 
10s. per case." This recommendation, though made in 1839, and repeated 
in 1841, has not been acted on; it has been left to the Guardians, to 
carry out or not, as they pleased ; and the result is known. The Poor Law 
Board may endeavour to shelter itself under the plea that the order has 
been issued ; but that is not enough ; it ought to have been enforced long 
ere this, backed as it was by the expressed opinion of the House of 
Commons in 1854." (See page 4, No. 4.) 

The Poor Law Board, if report speaks true, has admitted the payment 
to be inadequate to our services, but adds, whenever a vacancy occurs 
there are plenty of applicants for the office, and therefore it feels a diffi- 
culty in adding to the Poor Rates, by augmenting our salaries. This 
argument, however specious, I contend is not a fair one : our profession, 



11 

like all others, is overstocked, hence men are anxious to take any appoint- 
ment they hope may lead to something better ; but this is no reason why 
places of trust should be reduced to the lowest possible minimum ; and ours 
is a place of trust, since the lives of millions of the poorer classes are com- 
mitted to our charge. Were the Poor Law Board itself thrown open to 
public competition there would be plenty of candidates to supply the place 
of the officers, at half or even a quarter of their present salaries, but that 
does not prove it would be right to underpay them, as the Union Medical 
Officers now are. Let the duties of every office be ascertained, a fair 
remuneration fixed, and as vacancies occur, the best men chosen to fill them. 

No. 1275 and 1276. (M. B. Garrett, Esq.) — " It was some years ago 
when I took the medical appointment, and a drowning man will catch at 
a straw ; when young men commence practice, they are very glad of these 
appointments." " I thought it woidd be the means of bringing me into 
more general notice, and giving me more experience, and therefore, it was 
worth while to take it. My ideas of it are very much changed.' 

No. 2689. ( G. Wallis, Esq.M.D.) — "There are a great many districts which 
are so wide, that they would require special arrangement, but that could be 
easily adopted, because, I believe the expense would not be more than was 
reasonable and proper." 

No. 1657. (Dr. J. Griffin.) — " A man is now paid not for what he does, 
but for what he is expected to do, supposing the Medical Officer is not a 
conscientious man, but suppose Medical Men were paid per case, their 
object would be to show the greatest attention possible to the poor." 

No. 2058. (R. W. Rumsey, Esq.) — "I am sure, the present rate of pay- 
ment of Medical Officers, without coming upon their own resources, is quite 
inadequate." 

No. 2059. (R. W. Rumsey, Esq.) — "The consequence is, when expen- 
sive drugs are required, that either the Medical Officer must provide them 
at his own expense, or if he does not do that they could not be provided at 
all, or he will perhaps send them to the Medical Charities, the Infirmary, or 
the Dispensary, or he will induce them to enter a medical club, in fact, he 
will endeavour to shift the burden from his own shoulders." 

No. 2060. (R. W. Rumsey, Esq.) — " Which I conceive to be very detri- 
mental indeed to the poor, to be handed ab.out from one source to another, 
when their diseases require prompt and immediate treatment." 

No. 2242. (/. Leigh, Esq.) — " In some types of disease, I feel quite sure 
when Quinine is necessary to be prescribed in large quantities, it could not 
be furnished without serious loss to the Medical Officer at the sums of 
money now paid to him." 

No. 1734. (Dr. J. Griffin.) — " If you can make the duty and the 
interest of the Medical Men combine, you will get a more efficient attend- 
ance on the poor than you now do." 

No. 1874. (Rev. E. J. Howman.) — "I think the present system works 
badly for all parties; the Guardians are discontented, the Medical Officers 
are discontented, and the poor are discontented, because it opens the door 
to a multiplicity of evil, which, while it exists, I do not believe can be cor- 
rected ; the system of payment by salary tempts the Board to get as much 
out of their Medical Officers as they can for a smaller payment ; it tempts 
the Medical Officers to do as little as they can for their payment, and it 
tempts the poor to throw as much as they possibly can upon the Medical 
Officers, from the feeling that the Parish pays for them, so that they are 
inclined to make themselves paupers for the sake of medical relief." 

No. 1992. (Rev. E. J. Howman.) — " I do not believe that £300 a year, 
which might be a remuneration in 1837, when the population was only 
16,000, can be remunerative in 1854, when the population is 21,000; I 
think it works ill for all parties ; I think it works unfairly against the 
Medical Man, and I think it works badly as regards the wants of the poor." 



12 

No. 1994. (Rev. E. J. Howman.) — "We have now recently got two 
new Medical Officers, young men, who of course cannot afford, as the old 
practitioners do, to find themselves not in pocket, if they are not out of 
pocket hy their practice." 

No. 2000. (Rev. E. J. Howman.) — " I hear the Medical Officers all 
grumbling about being very much under-paid." 

No. 2960. ( W. Taylor, Esq.) — " I think it is the opinion of the majority 
of the Guardians that the Medical Officers are underpaid." 

No. 2962. (W. Taylor, Esq.)— "It the Poor Law Board gave an order 
for an increase of the salaries, I do not think it would be objected to." 

No. 377. (R. Weale, Esq.) — " I stated the attendance of Medical Men 
on clubs is inferior to that given to the poor." 

No. 499. (R. Weale, Esq.) — " Improvements have been made in 
Medical Relief since 1848 ; time has done a great deal towards improving, 
and it is a continually improving system." 

The Poor Law Medical Officers in their eighth request pray — 

" That the Poor Law Board be requested to define the class of persons 
entitled to Medical relief, and that it be not left to the discretion of the 
Relieving Officer, Overseer, or Churchwarden." 

Should a per case payment be adopted, in the form of a fixed salary, 
founded on the number of the cases attended in the previous year, or on an 
average of three years, which I think is preferable to a per case payment 
solely, it will be necessary to define the class of persons entitled to medical 
relief, otherwise the poor will be great sufferers. Experience, and the 
evidence laid before the Select Committee of the House of Commons, prove 
that where the Medical Officers are paid per case solely, orders in the early 
stages of disease, when it is most easily curable, are continually refused ; 
because, if liberally given, the Relieving Officer gets into disgrace with the 
Guardians ; thus, many a poor labouring man has been denied an order, 
whose earnings would not admit of him paying a medical charge, and the 
same system will be continued, in order to keep down the rates, unless a 
distinct line be drawn, and the present discretionary powers of the Relieving 
Officer removed. In a fixed salary the reverse system exists, and the 
Medical Man is inundated with orders, many of which, it was originally 
never contemplated he should have, as formerly he was required to 
attend paupers only, the labouring classes having their clubs ; these have, 
however, gradually fallen off, and the Guardians, with wonderful liberality 
— it being entirely at the expense of the surgeon — have given them orders 
for medical assistance, and by this means have increased his labour four- 
fold, the paupers being less than a million, whilst the working classes are 
four millions. Half of these, it is computed, required medical aid annually, 
and no doubt ought to be relieved at the cost of the State ; but such order 
for relief should not be left to the judgment or caprice of a relieving 
officer to give or withhold. Let medical orders be granted to every 
person above the age of 16 whose income from all sources does not exceed 
10s. per week, and to every husband and wife with their children under 16 
years of age, whose united income does not exceed 1 5s. per week, and let them 
have the power of obtaining a medical order from the Relieving Officer, 
Clergyman, Magistrate, Overseer, or Churchwarden of the Parish in which 
they reside. Let it be the duty of the Guardians to investigate these orders 
every board-day, and if it should appear the parties are not legally entitled 
to them to strike their names off the list. Let the Medical Officer receive 
2s. 6d. each case, for the services already rendered, with half the amount of 
mileage, and all the extras to which he may be entitled, the Guardians 
having the power to reimburse themselves by suing the party in the 
County Court. 

No. 2624. (G. Wallis, Esq., M. D.) — "The number of paupers made 
paupers through sickness, constitutes 72 per cent, of all those made paupers 
through all causes." 



13 

No. 2740. (G. Wallis, Esq., M.D.) — "The 72 per cent, is not a matter of 
opinion, but matter of fact." 

No. 2613. (/. Ellison, Esq.) — " In the per case payment, there is every 
inducement on the part of the Relieving Officer, to deal out medical orders 
with a niggardly hand, in order to keep down the pressure upon the rates, 
whilst at a fixed salary, the inducement is just the contrary." 

No.485. (R.Weale,Esq.) — "In the payment per case, Boards of Guardians 
frequently complain of multiplication of cases by Medical Officers, that 
occasion angry feeling between Medical Officers and Boards of Guardians." 
(This cannot exist if orders be given.) 

No. 1618. {Rev. C. Kingsley.) — "I do not suppose that Guardians are 
' hostes humani generis ' any more than other men ; my feeling is, that 
wheresoever you give a half-educated man, as the mass of rural Guardians 
are, considerable power, and that power bearing directly upon his own 
interest, you must expect that he will use it in a harsh and interested way, 
unless some one more educated calls out the good which is in every man." 

No. 160. (R. B. Cane, Esq.) — " The Poor Law Board recommend a 
fixed annual salary should be allowed for the infirm placed upon permanent 
Pauper list, and cases not on that list, paid for by per case payment." 

No. 167. (R. B. Cane, Esq.) — "The Poor Law Board did not recom- 
mend a per case payment should be adopted without reference to any 
other payment, it was to be combined with a salary for attending such poor 
persons as are permanently sick and disabled, and that a higher rate 
ought to be allowed for other cases which would require closer attention, 
medicine, and visits, than those merely suffering from age and bodily 
infirmity, in a chronic state." 

No. 165 and 205. (R. B. Cane, Esq.) — "I believe that the calculation 
of 6s. per case, by the Poor Law Board, did appear for some considerable 
period previously to the issue of the regulations providing fees for at- 
tendance upon surgical cases." 

No. 84. (R. B. Cane, Esq.)—" The Poor Law Board are able to lay 
down no rule as to the amount of a man's wages entitling him to medical 
relief; the decision rests absolutely with Guardians." 

No. 663. (R. Boyd, Esq., M.D.) — " I calculate a poor man will have to 
pay 3s. a month for medicine, at the cost price." 

No. 2053. (H. W. Rumsey, Esq.) — " I would supply no connection 
between out-door relief and pauperism; I would certainly not place a 
dispensary in the Union-house or Work-house." 

No. 2134. (H. W. Rumsey, Esq.) — "There should be no civil disability, 
and no disgrace attaching to the receipt of medical aid, that the medicine 
should be supplied separately, that there should be no impediment whatever 
to the application to the Medical Officer." 

No. 622. (R. Boyd, Esq., M.D.)—" I think that if medical relief had 
been given to the independent labourers more profusely than it was, it 
would have kept many from becoming eventually paupers." 

No. 634. (R. Boyd, Esq. M.D.) — " I believe that the labouring classes 
cannot afford to pay for medical attendance ; an exception may occur, now 
and then, but we must talk of the poor as we find them — and as a rule 
they cannot ; it is true, they do attempt it, run into debt, lose their 
independence and self-respect, and become dependent parish paupers, if 
nothing worse." 

Xo. 1023. (Mr. G. Chicle.) — "A labouring man, with 10s. a-week, could 
not find medical relief." 

No. 1029. (Mr. G. Chick.) — " I am decidedly of opinion that if Medical 
Relief were more freely given there would be less pauperism." 

No. 1030. (Mr. G. Chicle.) — "Medical relief should be given in the 
onset of the illness." 



14 

No. 1246. (M. B. Garrett, Esq.)—" I think the system of medical relief 
altogether deficient. I find there are great impediments in the way of 
obtaining orders for relief." 

No. 1347. (M. B. Garrett, Esq.)— "I felt as an Medical Officer that I 
could not do justice or my duty to the poor, in consequence of the opposi- 
tion I met with from the Relieving Officer." 

No. 1380. (Rev. C. Oxenden.) — "Pauperism is very largely increased by 
the want of prompt medical aid." 

No. 1389. (Rev. C. Oxenden.) — " The importance of giving to every 
labourer, every working man, an opportunity of receiving medical advice 
without any expence on his part, is of the first consideration ; because the 
absence of medical attendance at the very time when it is most needed, fre- 
quently results in the individual becoming for a lengthened period ill, and, 
consequently, a burden upon the parish, or if it terminate fatally, then his 
family becomes a still more serious burden." 

No. 1390. (Rev. C. Oxenden.) — " I should extend to all the working 
classes gratuitous medical relief up to 25s., a week, inclusive of the whole 
earnings of the family, also single persons not earning more than 10s. per 
week." 

No. 1392. (Rev. C. Oxenden.) — " I think it most important to extend the 
system of medical relief beyond the mere poor, so as to prevent persons 
from becoming poor ; the Doctor's bill is the bill which breaks down the 
labouring man." 

No. 2076. (H. W . Rumsey, Esq.) — " A man with 14s. a week, with a 
family, would be quite unable to find himself medical relief, worth calling 
such. ' ' 

No. 2089. (H. W. Rumsey, Esq.) — " There is no civil disability attach- 
ing to the receipt of medical relief in Belgium." 

No. 2090.) H. W. Rumsey, Esq.) — "And that should be adopted in this 
country." 

No. 2186. (H. W. Rumsey, Esq.) — "The poor object to apply to the 
Relieving Officer for medical relief, on the ground of the disgrace, also the 
difficulty they have in finding the Relieving Officer at home, and the uncer- 
tainty of obtaining an order." 

No. 2198. (/. Leigh, Esq.) — " Out of a total of 2,179 deaths in Man- 
chester, 726 had no medical attendance whatever ; a very great number are 
attended by druggists and other unlicensed practitioners." 

No. 2245. (/. Leigh, Esq.) — "The artisan residing in a town, and the 
common labourer residing in the country, are placed in very different posi- 
tions relative to medical relief ; Infirmaries and Dispensaries being mostly 
situated in towns, whereas in country parishes, a long distance from the 
Doctor, they have great difficulty, first, in getting orders, and then in 
obtaining the attendance of the medical man." 

No. 2246. (/. Leigh, Esq.) — " I would empower Medical Men at once to 
prescribe for, and to attend to the patients applying to them, and give them 
the means of referring such of their patients as are unable to purchase the 
medicines to the Dispensary, where they could at once have the prescrip- 
tion prepared." 

No. 2465. (Mr. G. Carter.) — "A man with 15s. a week, with a family 
of three or four children doing nothing, I do not think I should refuse him 
a medical note for either his wife or children." 

No. 2626. (G. Wallis,Esq.,M.D.) — "The working classes are estimated by 
Henry Mayhew at 4,000,000 ; it is a matter of fact, which, I believe, has 
been given in evidence before, that you may expect one half of those will 
be sick every year. If you consider the working classes form the material 
out of which you make all your paupers, you will see the great importance 



15 

of protecting that large class, who are so important to the interests of the 
country, from pauperism, and letting them remain useful and valuable pro- 
ducers, instead of being a deadweight upon the productive interests of this 
country ; the moment he becomes sick his independence is cut off, it cuts 
off his power to labour, and by cutting off his power to labour destroys his 
means of independence ; support him, by giving him a little medical aid 
when necessary, and thus prevent him becoming a pauper." 

No. 2647. (G. Wallis, Esq., M.D.) — "If a proper system of medical 
treatment were adopted and checked by a superior Medical Officer, upon 
the plan of the Army and Navy, the working classes would be in an 
infinitely better condition, and would not become paupers in the immense 
masses they do." 

No. 2729. (G. Wallis, Esq., M.D.) — " I consider the necessity of getting an 
order from the Relieving Officer to the Medical Officer is a serious detri- 
ment to the present system, because it creates such a loss of time. Mr. 
Charles Buller thought that in medical cases very little ought to be left to 
the discretion of the Relieving Officer. He ought not to be allowed to be 
the judge of whether a pauper was sick or not, that was a matter in which 
he was wholly incompetent to give an opinion, and I perfectly concur with 
him. I think he possessed almost intuitive knowledge." 

No. 3015. (W. H. Livett, Esq.) — "The average wages of the poor here 
are 9s. a week." 

No. 3016. (W. H. Livett, Esq.) — "It is quite impossible with those 
wages that they should be able to find medical relief, supposing either 
themselves or any member of their families become sick." 

No. 3020. ( W. H. Livett, Esq.) — " Two thirds of the cases I attend are 
not paupers before they apply to me ; they generally become so 
afterwards." 

No. 3023. {W. H. Livett, Esq.,)— ■" The Relieving Officer considers it 
his duty to make the order for relief difficult to be obtained." 

No. 3024. (W. H. Livett, Esq.)— "The Relieving Officer refuses an 
order in many instances." 

No. 3030. (W. H. Livett, Esq.) — "I think the intervention of the 
Relieving Officer is a course which leads to aggravated sickness." 

No. 2045. (H. W. Rumsey, Esq.) — "I consider it a very serious objec- 
tion that the sick have to apply for orders for medical relief, it stands in the 
way of prompt treatment of disease." 

No. 2061 and 2062. (H. W. Rumsey, Esq.) — " I object to every inter- 
vening authority between the sick man and the person appointed to take 
charge of his health, because in going for an order or ticket the poor 
may be driven from one source of medical relief to another, and they may 
find great difficulty in getting an order ; precious time is thus being lost in 
the treatment of disease." 

No. 2030. (H. W. Rumsey, Esq.) — "If medical relief had been promptly 
administered in all probability the illness would have been of slight dura- 
tion, and they would have been in the situation of independent labourers, 
instead of coming upon the poor rates." 

The third request of the Poor Law Medical Officers is — 

" That the scale of extras (including midwifery) shall be extended, and 
embrace many operations and bad cases in surgery not now paid for ; and 
that the Officer in charge of the Union-house shall participate in this arrange- 
ment with the District Officer, and there shall be no discretionary power to 
give a fixed salary instead of extras." 

From the returns of 500 district Medical Officers, it appears that 436 
have extras, which average Qld. per case; these, with their salaries of 
2s. 3d. each, make 2s. 9%d. per case. The salaries of the 64 whose extras 



16 

have been commuted, amount only to 2s. 4id. per case, shewing that the 
commutation has not raised their salaries to the ordinary average. A 
general feeling exists, that the extras ought to be restored ; their removal 
was, in most instances, effected without the voluntary consent of the Medical 
Officers ; it was forced from them at a time when they were annual 
officers, and they were given pretty plainly to understand that, if they did 
not consent, they would not be re-elected. The present scale of extras is 
far too limited ; it should include fractures of all the bones of the body, 
(excepting the fingers, the toes and the nose,) dislocations of the humerus 
and femur, and compound dislocations of the wrist and ancle — all serious 
operations ; burns and scalds, involving an attendance of more than one 
month, and the introduction of the catheter, if required longer than one 
week. Midwifery should also be paid at the rate of not less than 10s. 6d. 
per case, with treble mileage to compensate for the length of time taken up ; 
where the use of instruments is rendered imperative, an extra half-guinea 
should be given, and in each case where a second opinion is actually 
necessary, a fee of 10s. 6d. be paid to the Medical Officer called in, if the 
patient resides within one mile of his residence ; one guinea, if within four 
miles, and two guineas, if at any greater distance. All consultations, 
whenever actually necessary, to be paid for extra, the payments being 
made to the party called in at the same rate as for second opinions in mid- 
wifery cases. The surgeon of the Union-house should participate in the 
arrangement regarding extras, as it is well-known that a Union-house is, 
as it were, a hospital, many of the chronic and severe cases from the 
district being sent there for treatment, and requiring a vast quantity of 
medicine for their cure. It may be argued that he should receive less 
than the District Officer, as his patients are all congregated in one house, 
but, to counterbalance this, the cases, from their severity, are longer under 
treatment, the average duration being thirty-four days, thirteen hours ; 
he has also to examine all paupers on their admission, and is besides the 
Sanitary Officer of the house. 

No. 176. {R. B. Cane, Esq.) — " Surgical fees are only paid to District 
Medical Officers as the Medical Officer of a Workhouse is required to go 
there almost every day ; but if a district Medical Officer has to attend a 
case of fractured leg, it is necessary for him to make daily and special 
visits for many weeks, and of course he incurs great additional trouble and 
expense." 

No. 1714 and 1715. {Dr. J. Griffin.) — "All Medical Men object to include 
midwifery in the salaries, on the ground that they would get a great many 
more orders than when they had a separate payment for each midwifery 
case." 

No. 1718. {Dr. J. Griffin.) — "I think doing away with the extras will 
work prejudicially to the poor." 

No. 1725. {Dr. J. Griffin.)— "The Medical Men were told that the 
extras would be compounded for, and asked whether they would accept it ; 
they complained of the arrangement." 

No. 1726. {Dr. J. Griffin.) — " They consented to the arrangement under 
protest." 

No. 2680. {G. Wallis, Esq. M.D.)— " No cases of amputation should be 
done without a consultation." 

No. 2687. (6r. Wallis, Esq., M.D.)— " I would only pay the Medical 
Officer when he went out of his own district for the purpose of con- 
sultation." 

The fourth request of the Medical Officers is — 

" That all Poor Law Medical appointments, whether Union, Parochial, 
or under Gilbert's Act, not only now in force, but hereafter to be made, 
shall be declared permanent, subject only to good conduct. The districts, 
however, to be diminished or increased in extent from time to time, as the 
Poor Law Board or Public Authorities may think advisable." 



17 

" The Select Committee of the House of Commons in its third resolu- 
tion, recommend that every Medical Officer to be appointed after the 25th 
March, 1S55, should continue in office until he may die, resign, or become 
legally disqualified to hold such office, or be removed therefrom by the 
Poor Law Board." 

The Poor Law Board, in order to carry out the foregoing resolution, 
issued the following order : — 

" Every Medical Officer of a Workhouse, duly qualified according to 
the regulations of the Poor Law Board in force at the time of such 
appointment, and every district Medical Officer duly qualified as afore- 
said, and residing within the district in which he is appointed to act, 
shall hold his office until he shall die, or resign, or be proved to be 
insane by evidence which the Poor Law Board shall deem sufficient, or 
become legally disqualified to hold such office, or be removed by the 
Poor Law Board." 

In framing the foregoing order, the Poor Law Board no doubt intended 
to carry out the resolution of the Select Committee for the benefit of the 
poor, as well as the Union Medical Officers ; but, not being conversant with 
the matter on which they were legislating, it has resulted that, in a vast 
number of instances (146 out 500 replies, and, no doubt, it is in the same 
proportion with all) the Officers are not permanently appointed, and are 
still subject to annual election ; if not annually elected the rod is held over 
them in terror em. It arises this way, medical men generally reside in a 
town, which forms of itself a district, consequent^, only one so residing 
can be permanent, though perhaps, the adjoining district may not be fifty 
yards from the Surgeon's residence and his farthest patient not two 
miles off ; in some instances the street, or a river has formed a boundary 
line of the district, hence the man on the opposite side of the way is not 
permanently appointed. 

If residence constitutes the sine qua non for permanency of appointment, 
why should the Medical Officer of a Workhouse be permanent and not the 
District Officer, when it is well known that some of the former live further 
from their patients by miles than the latter 1 It may be well for the Poor 
Law Board to say, " some line must be drawn," but I respectfully submit 
this line should carry with it common sense. Make all Medical Officers 
permanent, whether resident or not, provided they reside not further than 
two or three miles from the centre of the district, and encourage the reduc- 
tion of the size of the latter as much as possible, and do not compel the 
poor to go from nine to fifteen miles for a Surgeon when they have one 
living within a short distance of them. 

No. 1594. {Rev. C. Kingsley.) — " All elections should be permanent, as 
the profession is exceeding^ over-stocked, and very young men try to 
struggle into a district to get the work out of the hands of the older, and 
more established and better medical men, and, if they can get hold of mid- 
wifery cases, and so introduce themselves amongst the farmers wives and so 
on, they get a hold and set up in the parish, taking the Union work at a 
dead loss, simply to get into midwifery practice. I think that any order 
for Medical Officers to be permanent would put a stop to that bad system 
of over competition by those young men, which is the case now." 

No. 2002 (Rev. E. J. Howman.) — " Competition as regards medical 
relief of the poor is decidedly bad." 

No. 2637. (G. Wallis, Esq., M.D.) — "An annual election would drive 
respectable men away from taking any part in it, that they would not be 
at the trouble of an annual election, and would not have a rod held over 
them in terrorem by Boards of Guardians/' 

The Poor Law Medical Officers in their sixth request pray — 

" That a revision of salaries take place triennially in each Union, if desired, 
either by the Poor Law Board, Boards of Guardians, or Medical Officers." 

The necessity of this must be obvious, a3 population is fluctuating, and 
sanitary measures may lessen the amount of sickness ; it is moreover just to 
all parties. c 



18 

No. 3082. (//. W. Livett, Esq.)—" I think if the whole of the salaries 
were revised and better apportioned to the work which is expected for 
them, it would tend in a great measure to palliate a great many of the 
evils which now exist." 

The Poor Law Medical Officers in their seventh request pray — 

" That medical orders shall continue in force for each case of sickness 
no longer than three months, and if renewed be counted as fresh orders." 

In all cases of illness lasting two months longer than the average 
duration, it is desirable that the Guardians should inquire into its cause, 
possibly the case would be better in a Hospital, or the patient may unne- 
cessarily continue on the Medical Officers book in order to obtain addi- 
tional relief, or if it be really a lingering illness, it is only fair that the 
Medical Officer should obtain additional payment, which a fresh order 
would give him ; in any case an inquiry would be beneficial. 

No. 1879. {Rev. E. J. Howman.) — "I believe, in a great measure, the 
Medical Officer was ordering extra diet in aid of general relief for aged 
persons, who really wanted additional assistance but had no disease to 
be cured, it was not curative." 

No. 1880. {Rev. E. J. Howman.) — " In fact he usurped the office of 
Relieving Officer." 

The Poor Law Medical Officers in their last request pray — 

li That a Medical Man, conversant with Union practice, have a seat at 
the Poor Law Board, and especial control over the medical department." 

This I regard as most important to the interests of the poor as well 
as their Medical Officers, as none but a Medical Man conversant with 
Union practice can properly carry out duties, which, judging from the 
returns already made, involve the welfare of at least 1,641,080 patients 
annually. Had such an officer been appointed years since, the proba- 
bility is that the medical department of the Poor Law would have been 
conducted satisfactorily to all parties, and there would not have been 
that odium attached to the Poor Law Board which now exists. A 
Medical Head would have pointed out to the Boards of Guardians the 
necessity of doing justice to their Medical Officers, and would have insisted 
on them being placed on an equitable footing, in order that they might 
do their duty by the poor, without injury to themselves. 

In Ireland such an officer exists, and why not in England 1 

No. 560. {A. Power, Esq.) — "The Medical Commissioner, in Ireland, 
is one of the five Poor Law Commissioners ; he is, to all intents and 
purposes, a Poor Law Commissioner, as well as having peculiar duties 
with reference to the Medical Charities Act." 

No. 562, {A. Power, Esq.) — " He receives, reads, and gives directions 
upon the papers arising under the Medical Charities Act." 

No. 563. {A. Power, Esq.) — " The Poor Law Commissioners in Ireland, 
are the Board of Health, and papers connected with this subject come 
more peculiarly under the notice of the Medical Commissioner." 

No. 564. {A. Power, Esq.) — "The duties of the five Medical Inspectors 
resemble that of the Poor Law Inspectors, but are confined to the ad- 
ministration of the Medical Charities Act." 

No. 588. {A. Power, Esq.) — " We obtain great advantage from a Med- 
ical Commissioner in the administration of the Medical Charities Act, and 
the Poor Law also." 

No. 1579. {Rev. C. Kingsley.) — "There should be some sort of central 
Medical Authority connected with the Poor Law Board, in the form of 
a Medical Commissioner, or General Medical Inspector, as there are many 
cases continually arising which might be much better decided by central 
Medical authority, than by Boards of Guardians or Poor Law Board itself." 

No. 1581. {Rev. C. Kingsley.) — "Medical Inspection would be satisfac- 
tory to the Medical Officers and the poor." 



19 

No. 1701. (Dr. J. Griffin.)— "I think if there were a Medical Poor 
Law Inspector in the character of an Assistant Poor Law Commissioner, 
to investigate the state of medical relief as it is administered to the poor 
now, and also the cases of abuses that occasionally are brought before the 
Boards of Guardians, it would be beneficial to the system in general." 

No. 1702. (Dr. J. Griffin.) — ".I do not think Sub-Inspectors are so 
necessary as a general Medical Inspector, to investigate cases of neglect 
brought before Boards of Guardians." 

No. 1703. (Dr. J. Griffin.) — "One Medical Inspector would have a 
great deal to do, but now the cases are brought before non-medical Poor 
Law Assistant Commissioners, who are not so capable of judging as a 
Medical Poor Law Assistant Commissioner would be, if the cases were 
brought before him." 

No. 3054. (H. W. Livett, Esq.) — " I would be content with one Medical 
Inspector at the Board above, to whom reference might be made in cases 
of dispute involving medical opinions and medical questions." 

SANITARY MEASURES. 

The duties of the Poor Law Medical Officers might be made available 
to improve the sanitary state of the Country. This could easily be accom- 
plished by transferring them from the Poor Law Board to the Board of 
Health, and making them the Sanitary Officers for their respective districts ; 
there would thus be a ready-made and powerful machinery for the pre- 
vention, as well as the cure of the diseases which now afflict the people. 
These gentlemen, from the nature of their occupation, are conversant with 
the localities that are productive of disease, and under the direction of a 
superior Board, would be enabled to insist on their improvement. The 
Legislature has empowered local Boards to appoint Sanitary Officers, but 
they have done so in a few instances only, and will not do it unless 
compelled, but they would not resist a class of men already in existence, 
having those duties assigned them. The health of a nation constitutes its 
wealth, it is therefore only fair that it should pay for its preservation, con- 
sequently, I would give the Poor Law Medical Officers such salaries from 
the Consolidated Fund as the Board of Health may from time to time 
advise. An improved Sanitary Condition of the people would lessen the 
poor rates materially. The Sanitary Officers already appointed are most 
of them a very superior class of men, and might either retain their 
offices, or have that of Medical Inspector offered them, in lieu of their 
present berths ; expense has hitherto deterred local Boards from appointing 
Sanitary Officers, as they think more of the opinions of the rate payers, 
whose votes they are afraid of losing at the next annual election, than they 
do of the health of the community. The state must therefore step in and 
enact the part of a parent, and pass such laws as will effectually preserve 
the health of the people at large. The Registrar General informs us that 
farmers and butchers are a short lived race of men ; elect Sanitary Officers 
throughout the kingdom, and it will soon be known that a dirty farm yard 
with its stagnant drain, or a filthy slaughter-house, is a fruitful source of 
disease to the whole neighbourhood, and cannot be permitted. There need 
be no alteration of the connection of the Medical Officers with the 
Guardians by whom they might still be elected, and to them make 
their weekly returns, though in a more simple form, each sheet being ruled 
to last 13 weeks ; the medical orders being entered in a book or separate 
sheet by themselves. These orders, as they are called, are at present only 
recommendations, and are frequently disobeyed by the Relieving Officer, 
which ought not to be sanctioned, as the Medical Officer must be a far 
better judge of the requirements of the patient than the Relieving Officer 
can be. The quarterly returns should be forwarded four times a year to 
the Board of Health, who would thus become acquainted with the locality 
of particular diseases, and be able to take measures to prevent their 
recurrence. These returns should be published in the same manner as is 



20 

now adopted by the Registrar General in the ease of deaths. In a new 
Bill it would be well to have medical attendance on paupers only charged 
to the Poor Rate, and the artisan incapable of paying for medical assistance 
and not in receipt of pauper relief, to the consolidated fund. The power of 
denning the class of persons entitled to gratuitous medical relief to be left 
with the Board of Health alone, unless Parliament fix the standard. In the 
table annexed to the vaccination paper, it will be seen that upwards of 
20,000 Children die annually from convulsions (a favorite term for a death 
that is sudden among children) these cases, and indeed all in which no 
Medical Man has attended immediately preceding death should be inquired 
into, and no person so proper to institute this inquiry as the Poor Law 
Medical Officer of the district. When there is no reason to suspect a death, 
took place from other than natural causes, he should give a certificate to 
that effect to the Registrar, if the reverse, to the Coroner for a further 
investigation. As payment, the Medical Officer should receive half a 
guinea, with mileage, and enter the case in his weekly return to the 
Guardians ; at present an inquiry is rarely instituted respecting the death 
of a child, though a preliminary one is now generally adopted by the 
Coroner, in cases of sudden death in adults, but this would be far more 
effectually performed by the Poor Law Medical Officer. 

No. 2070. (H. W. Rumsey, Esq.) — " Under improved sanitary regula- 
tions, I believe that a moiety of the population which requires gratuitous 
medical aid, in some form or other, might be reduced nearly one half, and 
therefore, I think it is extremely important to prevent the occurrence of 
sick cases by proper sanitary arrangements, rather than to adopt a system 
of medical relief which only has reference to the curing of disease." 

No. 1578. (Rev. C. Kingslcy.) — "A Medical Officer knows of nuisances 
better than any man, and it is he who must tell the Inspector in the long 
run." 

No. 1608. (Rev. C. Kingsley.) — " I think in many cases that the poor 
pay out of their own pocket, for diseases brought upon them by the 
neglect of others. I have seen many a case of disease which has come on 
entirely from the bad drainage, or bad building of a cottage. I think the 
greater part of the disease among our labouring poor is preventable 
disease." 

No. 1612. (Rev. C. Kingsley.) — "If perfect sanitary measures were 
carried out throughout the country, labouring classes, as a body, would be 
very likely able to pay for their own medical relief, so little disease would 
there be." 

No. 1629. (Dr. J. Griffin.) — "I think the present system is working 
very inefficiently as regards the poor." 

No. 2036. (H. W. Rumsey, Esq.)— "The duties of the Medical Staff 
throughout the country ought to be of a sanitary character, and I do not 
see how the question of public health, and that of public sickness can ulti- 
mately be separated. I would, therefore, recommend an addition to the 
present Board of Health of a Medical Section, with adequate powers of 
superintending medical relief, dispensaries, and various other matters dis- 
tinctly medical, which are now either neglected, or but imperfectly 
managed by the present Board of Health.." 

No. 2028. (H. W. Rumsey, Esq.)— "That the administration of medical 
aid be combined with the regulation of the sanitary condition of the labour- 
ing population, and be committed to authorities central and local, to b« 
constituted expressly for the management of this department." 

No. 2025. (H. W. Rumsey, Esq.) — " That the provision of medical aid 
for the out-door poor be separated from the administration of the Poor 
Laws, with the reservation of certain powers to the Poor Law Commis- 
sioners and the Beards of Guardians." 

No. 2029. (//. W. Rumsey, Esq.) — " So long as you connect medical 
relief to the poor with the Poor Law, so long will you continue to maintaia 
an increase of pauperism in the country." 



21 

No. 1345. {M. B. Garrett, Esq.)—" I think the Medical Officer ought 
to be removed entirely from the Board of Guardians." 

No. 13S8. {Rev. C. Oxcnden.) — •" I do not consider the present Poor 
Law satisfactory as to medical relief." 

No. 2072. {H. W. Rumsey, Esq.) — " You must open the door to medi- 
cal relief much wider, and you should have medical inspection, and then 
you would prevent the sickness which you are now at a great cost in 
relieving. 

No. 2065. {H. W. Rumsey, Esq.) — " I do not conceive that the medical 
and general relief should be submitted to the same principles, they must be 
administered upon totally different principles, and that it is burdening the 
Poor Law authorities with a matter which is bringing them into continual 
difficulties, both with the profession and with the public, and which might 
be much better managed under a separate and distinct department." 

No. 3045. {H. W. Livett, Esq.) — " It is not satisfactory to the Medical 
Officer to be put, as to medical treatment and medical relief, under the 
control of the Boards of Guardians." 

No. 3234. {C. F. J. Lord,. Esq.)— " If the management and control of 
Poor Law Medical Attendance was removed from the Poor Law Board and 
attached to the Board of Health, it would avoid the evil which springs from 
further centralization, and the difficulty of establishing a fresh Board. My 
opinion is, that if a comprehensive plan of that kind were carried out, it 
would conduce more than anything else to the proper regulation of the sub- 
ject of curative and preventive medicine, and that an efficient mode of 
medical relief to the sick poor, can be carried out with advantage to the 
country at large, by such a Board comprehensively acting in state 
medicine." 



VACCINATION. 

As vaccination is a part of the duty of the Poor Law Medical Officer, 
and the subject is likely to be brought before the Legislature next Session, 
it may be well to consider it in this place. It appears to me to be a matter 
for grave reflection, whether it might not be desirable to extend the time 
of vaccination to twelve months before the operation be made com- 
pulsory, and thus not only save expense to the nation, but what is of 
far greater importance, do away with some of the objections to vaccination, 
to which is attributed by the ignorant many of the diseases of which 
100,000 children (one sixth of the whole number born) annually die before 
they complete their first year. It may be urged that in extending the 
time, a number of lives may be endangered, but I question very much if 
this would be the case where the penal clauses enforced, as then the 
children of a riper age would all be vaccinated, and would not bring the 
disease from school or play, to their infantile brothers and sisters. In 
reference to a part of the annexed table, it will be seen that deaths from 
small pox have diminished since 1852, in which year 1954 succumbed to 
the disease before the completion of their first year, but in 1853 the deaths 
were only 861, and in 1854, 569. In extending the time, early vac- 
cination would not be denied those who desired it, but it would enable the 
poorer classes amongst whom the prejudice against it, and its very early 
performance principally exists, to postpone it as long as the law would 
permit. Had cow-pox been called modified small-pox, and people informed 
that it is small-pox deprived of its virulence by passing through the system 
of the cow, much of the opposition that has existed against vaccination 
would long since have passed away. 

In 1854, 677,886 children were vaccinated, which is nearly double the 
number of preceding years, but in 1855 they decreased to 448,519, arising 
in part from the people discovering that the threatened penalties were not 
enforced, and the Medical Men finding it did not pay them to lose then- 
time in searching out the un-vaccinated. 



22 





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23 

Of the 18,840,000 inhabitants of this kingdom, it is calculated that 
4,000,000 are of the labouring class, whose offspring only, in my opinion, 
ought to be gratuitously vaccinated, if from these you deduct the deaths of 
infants, under twelve months old, (and which fall heavier in this class of the 
community than in any other,) there will not remain more than 100,000 
requiring vaccination at the expense of the public ; for these, the nation 
ought to pay such a sum as will slightly remunerate the Medical Man for 
his labour, which cannot be at less than 2s. 6d. per case, with mileage. 
Confine gratuitous vaccination to the labouring classes, and you will confer 
a boon on the Medical Practitioner, by restoring to him his private patients, 
of which the Legislature has in many instances deprived him. The rate- 
payer will also be more satisfied and cease to clamour against compulsory 
vaccination, which had its origin more in the dread of the expense, than in 
any real hostility to the measure itself. In an amended Bill, J would 
attach the compulsory clause rather to the registration of vaccination than 
to vaccination itself, and simply insist upon all children being registered 
when vaccinated, and if this registration did not take place before the 
completion of the 13th month after birth, that a fine of 7s. 6d. should be 
inflicted annually, until such registration did take place ; the penalties to 
be recovered in the County Court, by the Registrar, whose duty it should 
be to sue the parents, or others having the custody of the child for the 
amount, and to retain it for his trouble. Those who are unable to pay for 
their children being vaccinated, should be entitled to claim an order for 
vaccination, from the Relieving Officer, &c, as in cases of ordinary sick- 
ness, the expense to he liquidated by the parish. Let a clause be inserted 
in the Act, that no child shall be admitted into any school, or public 
establishment of any description, or bound an apprentice, without producing 
a certificate of registration of vaccination, and in case of death from small 
pox, let the Registrar refuse a certificate for burial, unless a certificate of 
registration of vaccination, insusceptibility, or postponement be produced. 
In default, let a Coroner's inquest be held, and if it should appear that the 
parents, or others having the custody of an infant, had induced the 
disease by inoculation by themselves or others, or had wilfully exposed 
the child to the infection, declare them guilty of manslaughter. Rarely is 
any difficulty experienced in obtaining the registration of the birth of a 
child, and still more rare is it that a fine is incurred for non-registration 
within a given time. Let a similar provision be made in regard to the 
registration of vaccination, and the like results will follow. Do away 
with the numerous books, which serve only to harass the Medical Man. 
Let the Registrar give to the person who registers the birth of a child a 
paper, as at present, on which should be stated the necessity of registration 
within a given time, under a penalty of 7s. Qd. annually until it takes place; 
and on this paper, there should be forms of certificates for successful 
vaccination, insusceptibility or postponement, to which the vaccinator has 
only to append his name, titles and date. It should then be the duty of 
the parent &c, to take the paper to the Registrar, who would either append 
his name, and an official stamp to it, or provide him or her with another. In 
case of loss, provision should be made for a duplicate copy, on pajmient of 
a small sum. On removal from the place of birth prior to registration, it 
should be the duty of the Registrar to transmit a copy to the Registrar of 
the place of the child's nativity in order that the registry may be complete. 



The following correspondence is inserted as an illnstratiou of the nature of the 
complaints of the Union Medical Officers, and the little heed that is taken of 
them. 

Weymouth, 29th Sept., 1855. 
My Lords and Gentlemen, 

Three months since I addressed a letter to your Honourable 
Board praying for an increase of salary, and received a reply, dated July 
10th, in which was the following paragraph : — "The Board concur with 



24 

the Guardians in thinking, that although the number of cases attended by 
you during the period for which you have held your office, may have been 
unusually large, it is by no means certain that the duties have permanently 
increased ; the Board can only now add, that if this should be the case, 
they will give the subject of your salary their further consideration." On the 
faith of this letter, I have continued to carry on my duties for a second 
quarter, and regret to say, they have been more onerous than heretofore, as 
will be seen by a reference to the subjoined list. That they will still 
further increase during the winter half of the year, I fully believe, as 
during the past six months we have had fine weather, and consequently, 
only ordinary cases of sickness. My predecessor attended 642 cases last 
year, and received for them £110 ; I have attended 252 cases in the half 
year and have received only £17 10s. : whereas, had I been paid in the 
same ratio, I should have received £43 Is., or £25 lis. more than I have 
been paid ; he had on an average 3s. 5 d. per case, T have only Is. 4ld. 
It will be seen by a reference to the books that I return weekly on an 
average, 43 cases, for which I receive 13s. 5hd., or old. each, or a half- 
penny per day per case for attendance, operations, medicines, &c, a sum 
so grossly inadequate to the duties to be performed, that I must either give 
my services for nothing, or violate the trust reposed in me by neglecting 
the poor ; the latter, an effectual method to reduce the list of applicants 
for medical relief, but one that I cannot adopt. I accepted the appoint- 
ment under the impression that my duties would be no more than my pre- 
decessor's, and that the payment would be in proportion to his. In this I 
have been mistaken, and must therefore respectfully solicit you to recon- 
sider my salary, which can now be done, as none of the medical contracts 
are signed, and even if they were, I should imagine, by giving a month's 
notice they could be re-adjusted. I wish not to say aught against my col-. 
leagues, who I believe give entire satisfaction to the Guardians and the 
poor ; but it does appear to me most unreasonable, and which nothing can 
justify now that the duties are ascertained, that one should receive for 25 
orders a similar sum to myself who has had 252, or that a second, whose 
furthest patient resides closer to his house than my nearest one does to 
mine, should be paid £5 per annum more than myself, particularly when it 
is considered he has had one fifth less cases. It may appear strange that 
the number of cases have increased so suddenly, but those residing on the 
spot, particularly the Relieving Officer, can readily account for it. The 
truth is, the poor are satisfied with the care that is now taken of them, and, 
therefore, do not in a general way seek aid of private charity, or the public 
institutions. I trust 1 have satisfied your Honourable Board that I am not 
paid for my labour, and, therefore hope you will direct an enquiry into the 
subject, and give me a fair remuneration for my services, which I believe 
are entitled to some consideration at your hands, as during the half year, 
in addition to my ordinary duties, I have amputated a leg above the knee, 
removed a large tumour of seven years growth from the chest of a child, 
and amputated a man's finger near the wrist joint. 

Summary of duties performed during the half year, ending September 29th. 

Draughts 7 

Plaisters 7 

Confinements 3 

Amputation of thigh 1 

Removal of large tumour 1 

Amputation of finger near the 1 , 

wrist j 

Dressing wounds, ulcers, extracting 
teeth, sticking plaster, lint, and 
bandages. — No account kept. 

Payment received for the foregoing only £17 10s. 

I have the honour to be, &c, 
The Poor Law Board. RICHARD GRIFFIN. 



No. of orders for patients 353 

Visits at patients' houses 1507 

Visits by patients at Surgery... 481 

Mixtures 902 

Boxes of pills 277 

Liniments 44 

Lotions 110 

Boxes of ointment 101 

Packets of powders 91 

Blisters 23 



25 

12, Royal Terrace, Weymouth, 
30th September, 1855. 
Gentlemen, 

I beg to lay before you the accompanying copy of a letter which 
I forwarded yesterday to the Poor Law Board, (see the preceding letter), 
they will most probably communicate with you on the subject, should they 
do so, I most respectfully solicit your aid in support of my views, and if they 
should not, I trust you will give the subject your earnest consideration, and 
in conclusion beg to quote the words of Judge Willmore, in a recent trial 
at Yeovil. " If Medical Officers are screwed down too tight they are 
placed in a very painful position ; either they must be wanting in their 
duties to the poor, or they must be out of pocket, and one would not like to 
make a man suffer for his honesty, I am glad, therefore, for anything which 
promotes a liberal tendency in these matters." 

I have the honour to be, &c, 
The Board of Guardians, RICHARD GRIFFIN. 

Weymouth Union. 



Poor Law Board, Whitehall, 2nd October, 1855. 
Sir, 

I am directed by the Poor Law Board to acknowledge the receipt 
of your letter of the 29th ult., and to inform you that the statement which 
it contains will meet with their consideration. 

I am, Sir, your obedient servant, 
Richard Griffin, Esq., Weymouth. COURTENEY, Secretary. 



Weymouth, 13th November, 1855. 

My Lords and Gentlemen, 

I have just received information that the Board of Guardians of 
the Weymouth Union have again refused to augment my salary, postpon- 
ing its consideration until next March; this of course will be officially 
communicated to you. I need scarcely say, the course pursued is so mani- 
festly unjust to me, that I pray your Honourable Board will insist upon 
justice being at once rendered. I will not now go into details, as my 
letters of March and September are before you, further than to say the 
number of fresh orders last week were fourteen, and that in all respects my 
duties are as laborious as ever, therefore to ask me to work four month's 
and a half longer, when I have already earned twice as much as my whole 
year's salary, is positively unjust. 

I have the honour to be, &c, 

The Poor Law Board. RICHARD GRIFFIN. 



Poor Law Board, Whitehall, 
22nd Nov., 1855. 
Sir, 

I am directed by the Poor Law Board to acknowledge the receipt 
of your letter of the 13th instant, respecting your application to the 
Guardians of Weymouth Union for an increase of your salary as Medical 
Officer for the Weymouth district. I am directed to inform you that the 
Board have communicated with the Guardians on the subject, and have 
received a letter from them, in which they state to the effect, that having 
considered your application, they see no sufficient grounds for increasing 
your salary at present, but on the expiration of twelve months from the 
date of your appointment, they will give the subject their further consider- 
ation. Under these circumstances, and looking to the short period for 
which you have been the Medical Officer for the Weymouth district, the 
Board must decline to interfere further in the matter. 

I am, &c, 
R. Griffin, Esq. COURTENEY, Secretary. 



26 

Mr. Griffin's letter of the 9th of February, 1856, is omitted, as the 
answer from the Poor Law Board shews the nature of the communication. 

Poor Law Board, 14th February 1856. 
Sir, 

I am directed by the Poor Law Board to inform you that upon 
the receipt of your letter of the 9th instant, they communicated with the 
Guardians of the Weymouth Union on the subject of your representations 
and have received in reply a letter, from which it appears that the 
Guardians contemplated re-adjusting the Medical districts, and did not, 
therefore, consider it necessary to enter into any further contract with you 
as one of the Medical Officers, until they had received an answer to their 
intended application to this Board. 

I am, &c, 

R. Griffin, Esq. COURTENEY, Secretary. 



12, Royal Terrace, Weymouth, 6th March, 1856. 

My Lords and Gentlemen, 

I beg to enclose you the copy of a letter which I laid before the 
Board of Guardians of the Weymouth Union yesterday, as it is very desirable 
you should be in possession of every circumstance relative to the proceedings 
of the Board, in this affair, before giving your decision. Whatever may be 
the suggestions of the Guardians, I trust, for the sake of the poor, you will 
not consent to re-unite the districts, or even add two of them together. 
The division of the town into three districts was made only last year, 
because, as a whole, it was found to be too large, and worked badly for the 
poor; to re-unite it would therefore, be most injudicious, though it might 
provide a by-way to ged rid of an officer who has faithfully discharged his 
duties to the poor, but who has dared to make public the grievances he 
labours under. If that part of the parish of Wyke, situated within the 
Borough, be added to the Weymouth district, and that part of the parish 
of Radipole within the Borough, to the Melcombe district, and Fleet and 
Chickerell parishes be taken from a district which already extends fourteen 
miles across the country, and added to the Wyke district, and the parish 
of Owermoigne, situated nine miles from the surgeon's residence, be given 
to a Medical Man who resides within five miles, or to one of the Dorchester 
men, who are within six miles ; the districts would then be as well arranged 
as the residences of the Medical Men will admit, and you will not displace 
any of the present officers. With regard to the salaries, let me beg of 
you to insist that they be made equitable and commensurate with our 
services. 

I have the honour to be, &c, 

The Poor Law Board. R. GRIFFIN. 



12, Royal Terrace, Weymouth, March 4, 1856. 

Gentlemen, 

I have received a letter from the Poor Law Board, stating you 
contemplate re-adjusting the Medical districts. Permit me respectfully 
to suggest that mine should not be increased to any great extent, as it is 
already quite large enough, which will be evident when I tell you that up 
to the present time I have had 553 medical orders, and by the end of the 
year the number will probably be 600. I need hardly say these patients 
constitute a practice of themselves, and at times are as many as a man can, 
without difficulty, attend in conjunction with a private practice. Situated 
as your Medical Officers now are, I admit that a slight change would be 
convenient to those requiring Medical aid, viz. the addition to my district 
of that part of the Parish of Wyke, included within the Borough, and 
situated on the south side of the street leading from Rodwell to the Look 



27 



Out. By a reference to the medical Books, it will be ascertained how many 
patients each Medical Oificer returns, and I believe it will be found mine 
are nearly equal to all the others put together. I therefore beg to submit, 
that in a re-adjustment of the salaries, this circumstance should be borne 
in mind, and henceforward my salary bear its just proportion to the labour 
performed. Hitherto I have received one shilling and two-pence farthing 
per case, whilst some of my colleagues have had twelve times that amount. 
The £350 now paid amongst us cannot be considered a sufficient remu- 
neration for our services ; I therefore trust you will add to it such further 
sum as our labour fairly deserves. As a guide for your consideration, 
allow me to refer you to a copy of a minute of the Poor Law Board, dated 
6th June, 1839, and repeated in 1841 (see page 10.) Whatever course you 
may adopt, I am sure the welfare of the poor will be your first consider- 
ation, and this can only permanently be secured by giving a fair remu- 
neration to your Medical Officers, and making the districts so small that 
they may be efficiently worked. The propriety of the step you took last 
year in dividing the home district into three, is clearly proved, as the poor 
do not now, to any extent, seek aid of the private surgeons, with a promise 
to pay, which they are unable to fulfil, or of a retired practitioner (Mr. 
Fowler) who says his house is not now besieged, as formerly, or, of the 
public charities, as is evidenced by a subscriber to the Infirmary, who tells 
me, this is the first time that he has had Dispensary cards of a previous 
year still on hand. Subjoined is a list of the work performed by me during 
the 49 weeks I have held my appointment, the salary for which is only 
£32 195. 5%d., a sum so ridiculously small, that it cannot be considered in 
the light of a payment, but rather as a contribution towards the expenses 
for medicines and dispensing. 

I have the honour to be, &c, RICHARD GRIFFIN. 

Board of Guardians, Weymouth Union. 



Summary of duties performed 

No. of orders for patients 553 

Or an average of rather more than 

eleven fresh orders per week. 
Aggregate weekly return of 

patients 2545 

Or a weekly average, within a frac- 
tion of fifty-two. 

Visits at patients' houses 4834 

Or an average of nearly eight visits 

to each patient. 
Visits by patients at Surgery... 915 

Mixtures 2157 

Or an average of rather less than 

four for each patient. 
Boxes of pills 469 



by me during forty-nine weeks. 

Liniments 70 

Lotions 250 

Boxes of ointment 213 

Packets of Powders 200 

Blisters and Plasters 58 

Draughts, &c, 15 

Confinements 3 

Amputation of thigh 1 

Amputation at the metacarpus 1 
Dressing wounds, ulcers, extracting 
teeth, sticking plaster, lint, banda- 
ges, &c, — No account kept. 



Sir, 



Poor Law Board, 10th March, 1856. 



I am directed by the Poor Law Board to acknowledge the receipt 
of your letter of the 6th instant, and to inform you that the statements 
which it contains, shall meet with their consideration. 

I am, &c, 

Richard Griffin, Esq. COURTENEY, Secretary. 

12, Royal Terrace, Weymouth, 19th June, 1856. 

My Lords and Gentlemen, 

I have repeatedly complained to your Hon. Board and the 
Guardians of the Weymouth Union of the inadequacy of my salary com- 
pared with the duties I have to perform. I will not again trouble you 
with details, further than to say, I commenced the year with 47 patients 
on my list, and have since had 108 orders, making in the whole 155 



28 

patients; for these I shall receive £8 15s. or Is. lid. per case. During 
the live quarters that I have been the Medical Officer, I have had 687 
orders, whilst the Surgeon for the Melcombe district, with 200 orders less, 
has £5 annually more than myself; and the Surgeon for the Wyke 
district, with the same salary as myself, and a similar distance from the 
patients' residences, has had but 56 orders. I need not point out the glaring 
inconsistency of this disproportionate payment ; if my remuneration be 
sufficient, it is clear that of the other Medical Officers is more than suffi- 
cient, and the ratepayers are overcharged. If, on the contrary, the Wyke 
Officer is but fairly paid, I am most unjustly treated. The Board of 
Guardians, collectively, have given no reply to any of my letters but the 
first; in conversation with individual members of the Board, I am informed 
that they await directions from your Hon. Board on the subject; I trust, 
therefore, you will at once direct them to award me a fair remunerative 
salary, as you have the full and absolute power to do, as, I read in the 
Minutes of Evidence before a Committee of the House of Commons, May 
26th, 1854.—- R. B. Cane, Esq., (No. 12.)— "The law has confided in the 
Poor Law Board the absolute power of fixing the amount of salary, 
irrespectively of the Boards of Guardians, &c." 

I have the honour to be &c, 

The Poor Law Board. RICHARD GRIFFIN. 



Poor Law Board, Whitehall, 20th June, 1856. 

Sir, 

I am directed by the Poor Law Board to acknowledge the receipt 
on the 8th instant, of a memorial signed by yourself and others who were 
present at a public meeting of Medical and Surgical Practitioners, held at 
the Free Mason's Hall, London, on the 30th ult., on the subject of the 
duties and remunerations of Poor Law Medical Officers. 

I am directed by the Board to inform you that, that portion of the 
memorial which relates to the subject of the remuneration at present 
received by Medical Officers shall receive their consideration. As regards 
the request that the Board will, " in order to lighten the burden of the 
arduous duties of Medical Officers, direct the alterations recommended to 
be made in the form of Weekly Return;" the Board have carefully con- 
sidered the proposal, but are of opinion that the alterations suggested 
cannot properly be made, consistently with the due attainment of the 
objects for which the return is required. 

I am, Sir, your obedient servant, 

Richard Griffin, Esq. COURTENEY, Secretary. 



12, Royal Terrace, Weymouth, July 23rd, 1856. 

My Lords and Gentlemen, 

I received a letter from your Honourable Board, June 20th, 
acknowledging the receipt of the memorial signed by one hundred Medical 
Men ; in this letter you say, " as regards the request, that the Board will, 
in order to lighten the burden of the arduous duties of Medical Officers, 
direct the alterations recommended to be made in the form of the Weekly 
Return ; the Board have carefully considered the proposal, but are of 
opinion that the alterations suggested cannot properly be made, consistently 
with the due attainment of the object for which the Return is required." I 
have communicated this reply through the medium of the Medical Journals, 
to all the Union Surgeons, and am not surprised to find it has caused much 
regret, strengthening as it does, the belief openly expressed by many, that 
the grievances of the Union Medical Officers are little heeded by your 
Honourable Board. 

In this opinion, however, I cannot at present concur, believing the 
result of your deliberation has been arrived at, by viewing the Amersham 
weekly return sheet in its present form only, which was not intended by the 



memorialists, it being referred to simply a« one that prevents the useless 
labour of re-writing the names weekly, and that any other having the same 
end, would answer equally well. In quoting the Amersham weekly return 
sheet, it was thought that no objection could possibly be offered, it having 
already been stamped by the approval of your Honourable Board for the 
last twenty years, which of course would not have been the case had it not 
satisfactorily carried out your policy in that district. I can now only 
account for its rejection by assuming that it is your determination to lay 
down a uniform system throughout the kingdom ; with this view I venture 
to submit four forms for your consideration, trusting one of them may be 
admitted into the extensive reform so much needed, and which we confi- 
dently hope you have in contemplation. The weekly re-entry of names is 
decidedly objectionable for all statistical purposes, and is proved to be a 
great hardship by the fact that, not only has a memorial on the subject 
been presented to you by a large meeting of Medical Men, assembled 
from all parts of the kingdom ; but the pra}-er of it has been reiterated in 
other memorials from upwards of two hundred Unions, representing the 
opinions of from one thousand to fifteen hundred of your officers. I need 
scarcely add, that the addition of any one of the forms now submitted to 
your notice will be a great saving to the nation, and contribute to the 
relief of the Union Surgeons ; I will not now refer to the other part of the 
memorial, as I trust before long I shall have the pleasure of hearing from 
you, that your Honourable Board has decided to enforce a just and 
uniform system of payment throughout the kingdom as the law has em- 
powered you to do, and thus prevent the necessity of our petitioning 
Parliament on the subject next session. 

I have the honour to be, &c, 
The Poor Law Board. RICHARD GRIFFIN. 



12, Royal Terrace, Weymouth, Sept. 26th, 1856. 

My Lords and Gentlemen, 

I addressed a letter to your Hon. Board on the 23rd July last, 
enclosing certain forms for an Improved "Weekly Return Sheet; to this 
letter I have not yet received a reply — possibly it may have been over- 
looked, but should it however not be your intention to adopt any of the 
Forms, I shall feel obliged by their being returned, as it may probably 
be necessary to submit them, with other documents to Parliament, after the 
recess. 

I have the honour to be, &c, 

The Pcor Law Board. RICHARD GRIFFIN. 



Poor Law Board, Whitehall, 1st, Oct., 1856. 
Sir, 

I am directed by the Poor Law Board to acknowledge the receipt 
of your letter of the 26th ultimo, and in reference to your letter of the 23rd 
of July last, to inform you that the Forms which you then transmitted to this 
Board have not been overlooked by them, but that they wish to retain them 
for a short time longer, if they should occasion you no inconvenience by 
doing so. 

I am Sir, your obedient Servant, 
R. Griffin, Esq. R. N. GREY, Secretary. 



12, Royal Terrace, Weymouth, 2nd Oct. 1856. 

My Lords and Gentlemen, 

I beg to acknowledge the receipt of your letter of the 1st instant, 
and am happy to hear that the Forms have not been overlooked, and that 
you wish to retain them a short time longer, which I trust implies there is a 
chance of one of them being adopted, thus affording a slight relief to the 



30 

Union Medical Officers. Their prayer for a uniform and equitable rate of 
payment throughout the country, I hope will also meet with your favorable 
consideration, and that there will be no need of their again being compelled 
to ask the aid of the Legislature to enforce the recommendation of the select 
Committee of the House of Commons. 

I have the honour to be, &c, 
The Poor Law Board. RICHARD GRIFFIN. 



12, Royal Terrace, Weymouth, 12th Dec, 1856. 

My Lords and Gentlemen, 

On the 3rd of January last, I was requested by Mr. Puckett, one 
of the Weymouth Union Medical Officer, to see a Union patient of his, who 
had met with an injury eight days previously, and resided at Chickerell, a 
village three miles distant ; the man, aged about forty, I found confined to 
his bed with a dislocation of the humerus into the axilla, which, from the 
intense swelling had not been discovered • with the aid of Mr. Puckett, and 
my son, after twenty minutes great exertion I fortunately succeeded in 
reducing it, and sent in a bill to the Guardians for one guinea, which they 
refused to pay. 

On the 21st of the same month, I was again sent for by Mr. Puckett, to 
visit another Union patient of his, who had been in labour many hours, and 
resided at Osmington, a village four miles distant ; though ill at the time, 
and my proper place the bed, I proceeded without hesitation on a cold 
wintry afternoon, and in a miserable abode, passed several hours, (and this 
is the case with many a Union Surgeon, no marvel their days are shortened) 
I found the child's head impacted with the face presenting, and delivered 
the woman with instruments of a living child ; her dwelling was* a mere 
hovel of a wretched description, and the bed on the floor, which compelled 
me to assume, and for a considerable time to maintain a stooping position, 
causing me great personal discomfort, and stiffness in my back and arms 
for days afterwards. I charged one guinea, which the Guardians refused 
to pay. I remonstrated with the Clerk of the Board at the unfairness of 
the treatment, and asked him what I should do in future, saying a patient 
might die if I refused assistance; his reply was, "that's no business of 
yours." 

On the 3rd of this month I received a note of which the following is the 
copy :— 

Broadway, Dec, 3rd, 1856. 

Dear Sir, 

I have a case of constipation here, and Mr. Dade giving his 
authority for further advice and the Relieving Officer stating to me any 
expense he will see you satisfied. 

I remain, Dear Sir, your obedient servant, 

R. Griffin, Esq. ADAM S. PUCKETT. 

Not forgetting the previous conduct of the Guardians, I, on the impulse 
of the moment refused to go, but wrote a note to Mr. Puckett recommend- 
ing certain treatment, not wishing the man to be a sufferer. The 
messenger, Mr. Puckett's son, earnestly begged me to attend, assuring me 
the Relieving Officer would pay my fee, and that he had sent for me in 
consequence of the Rev. Mr. Dade, a magistrate, and the Clergyman of the 
parish having written to him, insisting upon him getting some other medi- 
cal man besides Mr. Puckett to see the case, and that he dare not go home 
without one, that if I would not go he must try and get some one else, but 
his father would rather have me, at last I reluctantly consented and hired 
a carriage for the purpose. On meeting Mr. Puckett, I narrated the con- 
versation I had held with his son, to which he replied, " You are sure of 
your money ; White, the Relieving Officer will see you paid," as he said 
to me, " Cost what it may you must get another Doctor, if it costs £5 I 
will pay it!" I visited the man who was suffering from constipation, and 
found he had been properly and actively treated by Mr. Puckett without 
effect. I therefore had recourse to inflation of the bowels with a pair of 



31 

bellows (a plan I had adopted in two other cases with success) and had 
the pleasure in about fifteen minutes of giving the man relief, as the bowels 
acted most copiously. The importance attached to the case will be appa- 
rent, when I inform your Honourable Board that Mrs. S., a lady of fortune, 
residing in the parish had sent unknown to the Relieving Officer and Mr. 
Puckett for her private medical attendant, Dr. Boyd, to see the man, who 
arrived a short time before me, and we all consulted together on the case. 
I did not see the Relieving Officer, but sent him by Mr. Puckett a bill for 
two guineas, a fair charge considering the importance of the case, and that 
I had to travel into the country on a cold rainy night, and to pay for the 
hire of a carriage. The Relieving Officer presented the account to the 
Board last Tuesday and the Guardians refused to pay it. I can therefore 
only imagine that they have not mental capacity enough to appreciate the 
value of intellect, that could suggest a simple measure to give immediate 
and perfect relief, but would probably have better understood the adminis- 
tration of a surfeit of pills, draughts, and clysters, even though the man 
had died under the treatment, and then possibly they would not have 
refused payment. 

These are cases which prove the absolute necessity of removing all con- 
trol of Medical Officers from Boards of Guardians, whom one would 
almost suspect of thinking more of their own pockets and those of the rate- 
payers than the lives of the poor entrusted to their care. I should have 
submitted the first two cases to your Honourable Board some months since, 
bat did not wish my private complaints to interfere with that of the more 
important one, the memorial of the Union Medical Officers in general, 
which I was in hopes was under the consideration of your Honourable 
Board, but from the length of time that has elapsed since its presentation,. 
I fear it is from the Legislature only we can hope for any general and 
comprehensive measure of reform. The President, Mr. Bouverie, will 
perhaps recollect my narrating the cases to him, though not officially, when 
I presented the general memorial of the Poor Law Medical Officers on the 
31st of May last. The time has at length arrived for me to call upon your 
Honourable Board to decide whether I am to be paid or not, as the Law 
gives you absolute power to do. To delay longer might endanger the lives 
of the poor in this locality, as it cannot be expected I should continue to 
sacrifice time and health without remuneration. After the several repre- 
sentations made by me to the Guardians and your Honourable Board of 
the inadequacy of my payment, and the gross injustice of my receiving on 
an average only Is. 2ld. per case, whilst one of my colleagues has 2s. Old. 
and a third 14s. for performing precisely similar services to mine ; I should 
have imagined, that although justice was denied me in the one case, the 
Guardians would, as a small compensation, have gladly rewarded me with 
liberality for any extra work I might perform ; but no, it is the reverse, 
and the Weymouth Union will have the unenviable notoriety of being one 
of the most unjust and illiberal in the kingdom. 

I have the honour to be, &c, 

The Poor Law Board. RICHARD GRIFFIN. 



Poor Law Board, 18th Dec, 1856. 
Sir, 

I am directed by the Poor Law Board to acknowledge the receipt 
of your letter of the 12th instant, and to inform you that the subject to 
which it relates will receive their attention. 
I am, Sir, &c, 
Richard Griffin, Esq. W. G. LUMLEY, Assistant Secretary. 



D. ARCHER, PRINTER, ROYAL LIBRARY, WEYMOUTH.